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Extremity Replantation is a comprehensive text covering all aspects of the upper and lower limb, with an emphasis on state-of-the-art techniques in the surgical and medical management of amputation and avulsion injuries as well as the current understanding of the recovery of function following replantation. It is organized following anatomical zones – thumb, digits, wrist, forearm and elbow; foot, ankle and lower leg – with special chapters dedicated to issues common to all replants, such as complications, medical management, nerve recovery and rehabilitation. Furthermore, the international team of authors demonstrates approaches from the entire spectrum of replantation care specialists, including plastic and reconstructive surgeons, orthopedists, and hand therapists. Generously illustrated with intra-operative photos, this book will serve as a standard reference for orthopedic, reconstructive, plastic, and hand surgeons as well as physicians or ancillary medical staff caring for the replant patient.
Posttraumatic stump formation and replantation of the severed limb are both reconstructive plastic operations which may lead to the improvement or destruction of a patient's lifestyle. For the primary attending surgeon, the decision whether to undertake such an operation depends on the patient's clinical condition, the operational circumstances, the psychological and social aspects and, last but not least, on the surgeon's own abilities. This monograph is designed as a synopsis of the great number of patho-physiological parameters and surgical and rehabilitational aspects which must be considered in the analysis of complications in major limb replantation. In addition, basic information about the key role of ischemic myopathy and microangiopathy is supplied to encourage further experimental investigations.
Implement TMR with Your Patients and Improve Their Quality of LifeDeveloped by Dr. Todd A. Kuiken and Dr. Gregory A. Dumanian, targeted muscle reinnervation (TMR) is a new approach to accessing motor control signals from peripheral nerves after amputation and providing sensory feedback to prosthesis users. This practical approach has many advantage
This practical and generously illustrated text presents the current concepts regarding the management of the mangled extremity, including microsurgery, vascular surgery, free tissue, nerve, hand, and replantation surgery. Since the advent of microsurgical reconstruction, significant progress has been made in the areas of replantation, free tissue transfer, as well as the refinement of skeletal fixation techniques. The scope will encompass the initial triage of a patient with a mangled upper or lower extremity, the initial and subsequent reconstructive efforts, to include skeletal fixation, vascular and soft tissue reconstruction, muscle and tendon transfers, psychological impact, therapy requirements, amputation considerations, and current data on salvage versus amputation in these scenarios. Case examples will be included to add further depth and context to the techniques and recommendations provided. Presenting these surgical challenges in detail, The Mangled Extremity will be an ideal resource for orthopedic and trauma surgeons, residents and fellows, as well as emergency surgeons facing these intense, traumatic injuries.
This volume in the Procedures in Reconstructive Surgery Series covers the key hand and upper extremity reconstruction techniques you need to stay on the cutting edge of this rapidly evolving specialty. Experts clearly explain how to perform procedures, sharing “tricks of the trade and clinical pearls so you can offer your patients superior results. Each book uses a concise, consistent format that complements the commentary. Master essential reconstructive surgical techniques with the comprehensive titles in this series! Provides real-life clinical details and clear visual guidance to the different operative steps with full-color illustrations and original artwork. Offers complete coverage of reconstructive techniques provided by well-recognized international authorities to provide balanced and comprehensive perspectives. Discusses common pitfalls, emphasizing optimizing outcomes, to refine the quality of your technique.
At the scene of injury Stop the bleeding with pressure bandage. Lift the extremity up. Collect all the severed parts of the body to be taken with the patient. Remember the possibility of replantation. Indications, see below. In the emergency room Inspect the stump and the severed part visually and, if necessary, palpate carefully wearing sterile gloves. An x-ray may be taken. Cool the amputated part. The patient is transported quickly to the place where final operative treatment is available. Call the receiving facility when referring the patient. The patient's opinion about the utility of a replantation is also considered.
The purpose of this study was to gain an in-depth perspective on the experience of replantation of a traumatically amputated upper extremity and the subsequent rehabilitation process through the point of view of a 15-year-old patient, his parents, his sister, and the treating certified hand therapist (CHT). As an occupational therapist it is important to understand the family relationships, support networks, and the role of the patient in the family. The therapist is in a unique position to provide treatment and emotional support that the patient and family need after experiencing trauma. This case study appraisal using a qualitative design included an exploration of the hand therapy chart (including the surgical report) and audio recorded interviews with the patient, each parent separately, the patient's sister, and the CHT. A three interview structure for in-depth phenomenological interviewing was used with the patient. The results of the chart review explain the surgical procedures, the therapeutic interventions, and the process of healing. The results of the thematic analysis of the interviews revealed three salient themes: pain (i.e. emotional and physical), transformation (i.e. transformation of self and roles), and miracles (i.e. surviving, retention of the limb, and retention of the family). The findings suggest that coping after a traumatic accident is a family process and all of the family members will experience this process differently.
Guest edited by Drs. Kyle Eberlin and Neal Chen, this issue of Hand Clinics will cover several key areas of interest related to Revascularization and Replantation in the Hand. This issue is one of four selected each year by our series Editor-in-Chief, Dr. Kevin Chung of the University of Michigan. Articles in this issue include, but are not limited to: Health Policy and Regionalization of Microvascular Hand Surgery and Replantation; Indications for Replantation/Revascularization; Efficiency in Replantation/Revascularization Surgery; Hand, Wrist, Forearm, and Arm replantation; Pediatric Replantation; Distal digital replantation and artery only protocols for replantation; Flap Coverage of dysvascular digits including venous flow-through flaps; Outcomes following replantation/revascularization surgery; Post-Operative Management of the Replanted/Revascularized Digit, including Rehabilitation; and Secondary Surgery following Replantation and Revascularization.